1780862789 NPI number — JASON G STENTOUMIS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780862789 NPI number — JASON G STENTOUMIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASON G STENTOUMIS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780862789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2257
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46304-0357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-676-9788
Provider Business Mailing Address Fax Number:
517-676-3438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2535 E MOUNT HOPE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48910-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-999-3935
Provider Business Practice Location Address Fax Number:
517-372-2542
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STENTOUMIS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-999-3935

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6301013410 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 680C315670 . This is a "BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com